Principles of Family Medicine

History and Definitions

Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine
Dr. Zekeriya Aktrk zekeriya.akturk@gmail.com www.aile.net

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What is a GP?

Golfing Practitioner?

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http://www.cartoondoc.co.uk

Objectives
At the end of this session the participants will be able to;
discuss the roots of family medicine explain the need for primary care explain the terminology used in PC discus family medicine as a distinct specialty discuss the features of family physicians

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What names and terms are used related with family medicine?
General practitioner (GP) General practice (GP) Family physician (FP) Family medicine (FM) Family doctor First contact physician Primary doctor Comprehensive care Primary care Primary care physician

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Flexner 1910
By 1910, there were 155 medical schools. There were no standards or guidelines for curricula He suggested that medical education should be conducted solely at university-affiliated centers located in urban areas with a curricular focus on specialized care.
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GP/specialist ratio: USA

90 80 70 60 50 40 30 20 10 0 1930 1940 1950 1960 1970
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The result of excessive specialization

Fragmentation Coordination problem between specialists Comprehensive care not available Continuous care not available Problems in medical education

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The popularity issue

Less income No respect Not taught at school Practice conditions not good Not suitable for political investment

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USA 1960s
35% of GPs practice badly Medicine and technology advanced but patients not satisfied No connection between undergraduate and postgraduate education Specialization routine No interest in preventive medicine Most of the population living in city centers
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Flexners mistake
Specialization = good doctors

Generalism is bad

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In fact
PC physician is aware of all specialties; he can recognize rare

diseases.
Common diseases are best known by GPs. Specialization doesnt prevent uncertainty; it only isolates the

problem from its environment, which hinders to see the whole

picture. As science advances, knowledge increases but the knowledge

load decreases.
Malpractice arises from less concern, not less knowledge
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What will happen without GPs?

Admission to hospitals and emergency units increases Specialists cant perform their real work Preventive medicine is not applied Has economic consequences Patients do not have a responsible carer
Decide by their own Pharmacy, friend Self treatment Alternative treatments
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From the Millis report (1962)

A peptic ulcer patient may need a surgeon, a
psychiatrist or a pharmacy. There is a need for

somebody who understands from all of these

branches. We cant force a patient to a resource who is not aware of the others!

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The primary care doctor looks at the whole movie, not the first picture!

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Leuwenhorst definition (1974)

General practitioner is a medical graduate who provides personal and continuous primary care services to individuals, families and population connected to a health center, without differentiating of age, sex and type of health problem. He is distinguished by synthesizing these functions. A GP can give his service at a office, home, clinic, or hospital.
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Wonca definition (2002)

Family medicine is a academic and scientific discipline and a primary care oriented clinical specialty with his own specific educational content, research, and base of evidence.
European definition of GP/FM, WONCA 2002

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Is general practice really a distinct specialty?

Is this formula correct?: Internal medicine + Pediatrics + Obs-Gyn + Psychiatry + Emergency = general practice
If we subtract the competencies gained from rotations, is there anything unique for GP?

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Basic components of GP/FM

Access to care Continuity of care Comprehensive care Coordination of care Contextual care
Saultz 2001
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Basic principles of FM/GP

Point of first contact with the health system
Open and unlimited service opportunity Independent of age, sex or any other feature of the person

Easily accessible
Geographically Economic Culturally
Rakel 2003 20 / 26

 Integrated and coordinated service:

Preventive, curative, and rehabilitative Coordination between different service levels
Consultation, referral, follow up

Continuous health care:

Time, person, place, records, and interdisciplinary
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 Comprehensive care:
All conditions related with health Physical, psychological, social

Personal care:
Person centered

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 Family and population oriented:

Family and population aspects of problems Health problems of the population Coordination with other sectors, occupational groups and voluntary organizations

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 Privacy and closeness :

Spread over the life span, a continuous and close relationship

Advocacy:
In all health affairs and relationships between other members of the health team

Efficient use of health resources:

Prescription, referral, consultation, laboratory investigations, hospitalization
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 Specific communication and clinical decision making

Effective communication, Undifferentiated health problems, Specific decision making process defined by the incidence and prevalence of the disease in the population

Team work:
Other disciplines, other health personnel, social services, education services, employers
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